The Study Of Focal Liver Lesions With Three-dimensional Contrast-enhanced Ultrasound

Objective: To study the ultrasonic performances of focal liver lesions (FLL) withThree-dimensional Contrast-enhanced Ultrasound (3D-CEUS), and to find the clinicalvalue of3D-CEUS.Methods: The PHILIPS IU22ultrasound scanner including C5-1probe and V6-2dimensional volumetric probe, and SonoVue ultrasound contrast agent injected byintravenous bolus injection technique, were used to perform2D-CEUS examinationand3D-CEUS examination on127lesions. All the lesions were enhanced in earlyarterial phase with2D-CEUS examination. The2D-CEUS examination wasperformed first to observe the enhancement pattens in the arterial phase and thecontrast-enhanced modes of the lesions, then the3D-CEUS examination wasperformed to observe the enhancement pattens in the arterial phase, internal structuresof lesions, and number of feeding vessels, distribution and sharp. The parameters ofthe two examination methods was compared to confirm their diagnostic value inlesions.The difference was statistically significant when P <0.05.Results:1. The typical-performances of FLL with3D-CEUS were as follows:74of75(98.7%)hepatocellular carcinoma (HCC) lesions performed as early homogeneous orheterogeneous enhancement (solid boll-like) with multifocal (when the size largerthan2cm, for the numbers of HCC blood vessels increased with sizes) and disorderinterior vessels which extended from peripheral vessels. All the31(100%) hepaticcavernous hemangioma (HCH) lesions performed as ringlike enhancement orcentripetal enhancement (hollow boll-like) with peripheral regular nodular vesselsgathered on one side.10of11(90.9%) focal nodular hyperplasia (FNH) wereperformed as centrifugal enhancement with a internal radial nourishing blood vesselsoriginated from external.7cases of hepatic abscess lesions performed asheterogeneous enhancement with regular normal region vessels extended to the internal of lesions.2cases of perivascular epithelioid cell tumor (PEC) performed asearly homogeneous enhancement with multifocal irregular peripheral vessels withoutextending to the inside.1case of primary hepatic lymphoma (PHL) performed as earlyhomogeneous enhancement with peripheral thick vessels staggered and straightlyextended to the internal of lesions.2. The performances of FLL by3D-CEUS in the atypical-performances cases with2D-CEUS were as follows.1)8of75(10.7%) HCC lesions were atypical with2D-CEUS,3lesions were ringlike enhancement in the arterial phase while with3D-CEUS there were multifocal and disorder interior vessels extending fromperipheral vessels. And5lesions were isoechoic in the late phase while with3D-CEUS they all represented as typical-performance of HCC lesions.2)5of31(16.1%) HCH lesions were atypical with2D-CEUS.4lesions were earlyhomogeneous enhancement, another one lesion was ringlike enhancement andwashout early, while with3D-CEUS they all represented as typical-performance ofHCH lesions.3)3of11(27.3%) FNH lesions were atypical by2D-CEUS, they wereperformed as early homogeneous enhancement instead of centrifugal enhancement,while2of them represented as typical-performance of FNH lesions.3. The detecting rate of feeding vessels were significantly higher by3D-CEUS(100%) than by2D-CEUS (74.7%,56/75). And the number of feeding vessels waspositively correlated to the size of the lesions (P<0.05, rp=0.625), while had nosignificant relationship with the differentiation degree of the lesions (P>0.05).Conclusion:Each focal liver lesion had characteristic performances with3D-CEUS, they mainlydiffered in enhancement patterns, distribution and morphology of the feeding vesselsin arterial phase. The3D-CEUS is superior than2D-CEUS on the detection rate andquality of feeding vessels. The3D-CEUS improved the capabilities of differentialdiagnosis in the atypical-performance cases with2D-CEUS.3D-CEUS examinationbased on2D-CEUS had important clinical value in qualitative diagnostic of FLL.